Approaches to Rehab
When applied to substance use disorders, the term rehabilitation covers the therapy needed after detox to help the individual change their behavior around intoxicating substances like drugs or alcohol. Addiction is a disease of the brain, which reinforces itself through compulsive behaviors to ingest intoxicating substances, which creates pleasure and a sense of reward by releasing neurotransmitters like serotonin and dopamine. Once a person has been tapered or weaned off their body’s dependence on these drugs to feel normal – the detox process – they must enter a rehabilitation program to understand how addiction affects them. Professional therapists and the social support of group therapy can help the person change their behaviors to avoid intoxicating substances and live a healthier life.
Although rehabilitation is a necessary component to help a person overcome addiction, there are numerous approaches to this kind of treatment. Options include residential or outpatient treatment; faith-based or secular groups; holistic options; and much more. Each treatment option should provide the individual with a sense of empowerment to stay sober and a support network to maintain that sobriety.
Basic Types of Rehabilitation
The National Institute on Drug Abuse (NIDA) recognizes four basic approaches to treatment. These could differ in the style of psychotherapy provided, whether or not they offer medication assistance, and how long they last.
Inpatient rehabilitation: Also sometimes called short-term residential treatment, this is one of the more common forms of treatment for substance abuse. The original residential treatment programs were 3-6 weeks, and many private insurance companies still at least partially cover that length of treatment. However, NIDA recommends at least 90 days, or three months, in substance abuse treatment (inpatient or outpatient) to fully change behaviors around substances. People who go through inpatient rehabilitation do best if they continue receiving emotional and social support through support groups and/or professional therapy.
Long-term residential care: This form of substance abuse treatment provides support and assistance fulltime; the individual in treatment lives in the facility until they have completed the program, which could take several months. In some cases, the length of stay is 6-12 months. This is because long-term residential treatment uses the concept of a therapeutic community (TC) to provide emotional and medical support during detox, then ongoing emotional and social support to change behaviors around cravings, symptoms, and lifestyle.
Outpatient rehabilitation: This form of substance abuse recovery works well for people who need to, or want to, remain at home during treatment because they have family or work commitments, or they have enough support avoiding drugs or alcohol at home that they do not need to move away from triggers that might lead to relapse. Outpatient rehabilitation programs require a specific number of therapy meetings per week – usually between one and three, although it can be as many as six – and may include medication assistance, like buprenorphine, to help the individual taper off their dependence on certain substances.
Intensive outpatient programs: Several therapy sessions are scheduled over a period of days or weeks (usually less than one month), lasting for several hours a day. The individual can live at home, but they typically must take time off work or school due to the time requirements of the intensive outpatient program (IOP). These programs are good alternatives to inpatient treatment. They provide social support and access to therapists at a level usually provided by inpatient rehabilitation while greatly reducing the cost of treatment, which makes IOPs more accessible.
Types of Therapy Applied in Rehabilitation Programs
Different rehabilitation programs may employ different therapeutic approaches to treatment, both in group therapy and individual therapy sessions. As a better understanding of addiction treatment enters the medical and psychological fields, types of therapy are being combined. The foundational types of therapy used in drug and alcohol rehabilitation are outlined below.
Cognitive Behavioral Therapy: While this style of therapy may be combined with other types of therapeutic treatment, like Motivational Interviewing, Cognitive Behavioral Therapy has proven to be one of the most affective approaches to overcoming substance abuse and staying sober. This type of therapy uses positive reinforcement for good behaviors, like avoiding drugs or alcohol, paired with negative reinforcement, like understanding withdrawal symptoms or hangovers as downsides of substance abuse. A therapist will guide their client through verbal analysis of their behaviors and the effects these behaviors produce. This form of therapy also explores the conflict between how a client wants to act and what they actually do.
Motivational Interviewing: Developed to help problem drinkers understand that their patterns of substance abuse could cause social and health problems, and help them overcome resistance to entering treatment, Motivational Interviewing (MI) has evolved to address other kinds of addiction too. It is especially effective for adolescents struggling with substance abuse issues because this age group does not have the agency to refuse treatment. The approach uses questions, so the therapist can guide their client to an understanding of how patterns of drug or alcohol consumption cause problematic behaviors, situations, and have long-term health consequences. The focus is on collaborating with the client, rather than confronting them.
Contingency Management: This form of therapy uses positive reinforcement in the form of specific rewards, like vouchers or prizes, to help those in therapy feel rewarded for taking appropriate steps in their drug addiction treatment. This form of therapy works well, according to NIDA, for those overcoming alcohol, stimulant, opioids, nicotine, or marijuana addiction. Incentives-based therapy helps people overcoming substance abuse want to stay in treatment, so there is a higher treatment retention rate.
Family therapy: This form of therapy works with the whole family dynamic, so environmental triggers for addiction and other mental health problems can be understood, behavior can be changed, and trust in the family unit can be rebuilt. This form of therapy also helps the family better support their loved one while they undergo treatment in a rehabilitation program.
Medication-Assisted Treatment (MAT)
There are many substances that do not have medications to ease the body off dependence on them; however, there are important pharmacological treatments available for people struggling with alcohol use disorder, opioid addiction, and tobacco addiction, which can make detox and rehabilitation more effective. These drug treatments replace the addictive substance and then help the brain balance neurochemistry on its own by slowly tapering the replacement medication until the individual’s body no longer needs the presence of drugs to feel normal.
Common drugs used in MAT include:
- Buprenorphine: A partial opioid-agonist, this long-lasting drug binds to the opioid receptors in the brain but does not induce euphoria like heroin, OxyContin, fentanyl, or other opioids that are commonly abused.
- Acamprosate: This drug eases withdrawal symptoms associated with alcohol use disorder, including anxiety, restlessness, dysphoria, and the risk of seizures or delirium tremens. The drug acts on GABA neurons.
- Bupropion: Originally used in Wellbutrin, a treatment for depression, bupropion has been found to be very effective in reducing cravings for tobacco, easing the transition away from smoking.
Holistic Treatment Options in Rehabilitation Programs
The National Center for Complementary and Integrative Health (NCCI), a division of the National Institutes of Health (NIH), lists dozens of therapies based in gentle touch, nutrition, herbal medicine, energy healing, and more. According to NCCI, about 38 percent of American adults use some form of holistic, alternative, or complementary treatment for all kinds of ailments; this includes treatments to overcome substance abuse and maintain sobriety. Many rehabilitation programs are beginning to use alternative therapies to aid in a more balanced approach to treating the entire individual while they work to end their addiction.
Some types of holistic treatments provided by rehabilitation programs include:
- Acupuncture: Based on traditional Eastern medicine, which approaches the body as a complex web created by the opposing forces of yin and yang, acupuncture uses stimulation of specific points in the body to bring the whole person into greater balance of these forces. Acupuncture may include inserting needles, but it can also use small electrical pulses or other types of pressure on these areas. Acupuncture appears to work well for chronic pain, so people in a rehabilitation program who also struggle with pain related to detox or an underlying illness may benefit from this treatment.
- Massage therapy: This form of therapy helps to bring the body and mind back into alignment. It can also help to manage pain, acute withdrawal symptoms, or chronic issues related to substance abuse. Relaxation is promoted by loosening tense muscles using gentle touch or specific pressure, depending on the style of massage.
- Mindfulness and meditation: Mindfulness is based on meditation, which has many traditions in various spiritualities or faiths around the world; however, the primary forms of meditation practiced in the West are inspired by Buddhist traditions. Both mindfulness and other meditation techniques help a person become aware of experiences, both thoughts and behaviors, that cause them suffering. By becoming aware of these problems, mindfulness and mediation both promote acceptance and letting go of judgment. This can help a person in a rehabilitation program by acknowledging their substance abuse, lingering issues like cravings or self-blame, and understanding that they can improve their lives.
- Music therapy: Used as a type of therapy for many learning, emotional, and behavioral disorders, music therapy can help people relax while they are in rehabilitation, stimulate neurotransmitters so they feel better and more satisfied, and bring groups together by learning instruments, singing, or playing music together.
- Yoga: This form of exercise can range from gentle to vigorous, but it has generally been found to successfully combine stretching and strengthening techniques through holding or working through poses. As a therapy, yoga can improve the body/mind connection, bringing a person into awareness of issues they experience, like withdrawal symptoms or cravings, while helping them improve stamina, balance, strength, and flexibility.
A support group is a gathering of similar people who help each other through the recovery process. Support groups are important after a rehabilitation program is completed, so individuals can maintain social support in a group of peers. They can also be a vital component of drug rehabilitation during treatment, especially outpatient treatment.
Faith-Based Support Groups
A Washington Times article reports that 84 percent of the world participates in some form of faith, religious denomination, or worship. A PEW Research survey of 35,000 Americans found that nearly 71 percent reported being Christian, including evangelicals and Catholics. However, the US has long been home to many faiths, including Judaism, Islam, Buddhism, and Hinduism. Faith represents a large part of life for millions of Americans, so it should be unsurprising that numerous rehabilitation programs include a component of religious worship or belief in a higher power. This understanding of life and the world helps many people overcome substance abuse.
Alcoholics Anonymous and the 12-Step model: AA is a support group founded on 12 Steps created to help people struggling with alcohol use disorder overcome the condition. Many 12-Step-based programs exist today, helping those who struggle with other kinds of addiction as well. The famous 12 Steps are:
- Admitting one’s powerlessness over addiction
- Acknowledging belief in a higher power (sometimes God, but not always) that restores sanity and sobriety
- Turning one’s will over to the higher power
- Searching oneself to understand morality around substances and the world
- Admitting one’s wrongs
- Asking the higher power to remove character flaws
- Asking the higher power to remove shortcomings
- Making a list of people who were harmed by the substance abuse and being willing to make amends with these people
- Making direct amends wherever possible, unless it would make the situation worse
- Making a personal moral inventory an ongoing practice and admitting wrongs promptly
- Improving one’s understanding and conscious contact with the higher power/God
- Bringing this message of help and self-efficacy to others struggling with addiction
While the Anonymous support groups began with Alcoholics Anonymous, there are a dozen specific types of groups, covering compulsive behaviors and substance abuse. These are:
- Chemically Dependent Anonymous
- Cocaine Anonymous
- Crystal Meth Anonymous
- Dual Recovery Anonymous
- Families Anonymous
- Marijuana Anonymous
- Narcotics Anonymous
- Nicotine Anonymous
- Pills Anonymous
Salvation Army: Founded on Christian faith, the Salvation Army has provided substance abuse treatment services for free for over 100 years. Treatment options include residential treatment at Harbor Light and other adult rehabilitation centers offering support groups. The focus of treatment with the Salvation Army is social, emotional, and spiritual. Most of their centers provide group and individual therapy, housing, and work opportunities. Charity-based rehabilitation programs do not accept government funding and instead run on donations.
Jewish Alcoholics, Chemically Dependent Persons and Significant Others (JACS): Formerly Jews in Recovery, this program uses founding principles in modern Judaism to help members of the faith overcome addiction to alcohol or drugs. The larger group of programs offer support and guidance through Judaism, with an evidence-based understanding of addiction as a disease and how chemical dependency can affect the Jewish community.
Millati Islami: A Muslim-based fellowship of men and women supporting each other through recovery and ending addiction to intoxicating substances, using the Path of Peace and other principles of Islam. While the central faith is Islam, the philosophical foundation of the support group is based in the 12 Steps.
An Alternative Step Program
One of the most important components of recovery is social support, and for many, this takes the form of attending a local support group. The concept of a support group began with the 12 Steps, but many have moved away from the faith-based program while retaining the idea that working together and supporting each other through recovery improves outcomes.
Rather than the 12 Steps, Self-Management and Recovery Training (SMART) uses four steps to help those in the support group maintain abstinence from alcohol or drugs. These steps are:
- Building and maintaining motivation to stay sober and on the recovery track
- Coping with urges using various techniques
- Managing thoughts, feelings, and behaviors
- Living a balanced life
There are in-person meetings all over the US, and meetings are also available online. SMART was one of the first support group and addiction recovery self-help programs to avoid faith-based treatment and to instead focus on the medical understanding of substance abuse.
Non-Step Support Groups
The concept of taking specific steps to completely overcoming an addiction has a great deal of power: the person entering rehabilitation or the support group has a plan laid out for them, so they can check off steps as they make progress. However, steps-based programs do not work for everyone; instead, a more generally supportive approach to maintaining abstinence or overcoming relapse works better for some. These programs do not rely on steps, but they still provide effective support for overcoming addiction and maintaining abstinence.
- LifeRing: A secular form of a recovery support group, this group gathers people to share practical experiences, ask questions, and support each other by acknowledging the many ways to live a sober lifestyle. Because there is not a focus on religion or spirituality, LifeRing instead guides members with the understanding that each individual has the ability to stay sober, with social support.
- Moderation Management: Based on data from the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) that found there are four times more problem drinkers than people suffering alcohol use disorder in the US, Moderation Management focuses on helping people who binge drink, drink heavily, or have other symptoms of problem drinking to curb their alcohol consumption and avoid alcohol use disorder. The desire of Moderation Management is not to stop people from consuming alcohol, but to help a larger population understand what moderate consumption of alcohol looks like and change behaviors accordingly.
- Rational Recovery: A nationwide support group based on a bestselling book: Rational Recovery, the New Cure for Substance Addiction. The book uses evidence, like changes to the reward system of the brain, to approach a better understanding of what addiction is and how it affects behavior and psychology. The book introduces the Addictive Voice Recognition Technique (AVRT), which identifies cravings as a separate mental expression, not the driving force of a person’s life.
- Women for Sobriety: A self-help program and support group founded in 1976 specifically for women suffering from alcohol use disorder. The program has expanded to support women who want to overcome other kinds of substance abuse as well, including benzodiazepine, opioid, cigarettes, and cocaine addictions.
Online Support Groups
While many people benefit from attending a support group in person, this may not always work out. Some people travel for work; others may simply live too far away from the meeting that would work best for them. Sometimes, a person may not be emotionally or physically well enough to leave home but still needs support in recovery. Fortunately, with greater online access, many people have started support groups online.
- AboutAlcoholism: This is an online message board for those overcoming alcohol use disorder, with a section for loved ones too. One section is specifically related to the 12 Steps while the general discussion and other areas do not focus on this type of support group.
- StepChat: A collection of steps-based online forums offering consistent support from individuals all over the world, not just the United States. These options work well for people who have difficulty leaving their homes; those who have busy work schedules or lots of family demands and cannot make time to leave the home to attend support groups; or those who live in remote areas who may not wish to travel great distances to attend a meeting.
Paying for Rehab
While most insurance programs and states provide some coverage for rehabilitation programs of all kinds, there are specific populations who may need additional help. Certain organizations support specific demographics with financial coverage so people can enter a drug or alcohol rehabilitation program.
- Medicaid: Prior to the passing of the Affordable Care Act (ACA), Medicaid did not cover substance abuse treatment or treatment for co-occurring disorders, except in rare cases when a parent of young children or a pregnant woman struggled to get off drugs or alcohol. Now, requirements listed by the ACA, including making mental health and substance abuse treatment accessible, have widened the options for people who have low income levels. Federal Medicaid dollars are given to states, who then fund appropriate treatment programs covering populations with great financial and/or medical need for substance abuse treatment.
- Social Security disability insurance: For qualifying individuals, SSDI may cover up to 45 days of inpatient drug rehabilitation.
- Veterans’ benefits: For those who have served in the United States military in some capacity, the Department of Veterans Affairs (VA) offers comprehensive substance abuse treatment. Veterans who are struggling with alcohol or drug abuse can get help with medical, social, and vocational interventions as well as rehabilitation therapy, including Cognitive Behavioral Therapy and medication-assisted treatment. Medical programs are evidence-based, and they use detox, rehabilitation, and long-term psychiatric care to help veterans overcome substance abuse and maintain ongoing sobriety.
- Drug treatment in prison: Many of those who are incarcerated enter prison with a substance abuse problem, so the Federal Bureau of Prisons (BOP) maintains drug treatment specialists in several prison facilities to assess inmates for potential treatment needs.